Provider Demographics
NPI:1700529815
Name:STALLER FAMILY PRACTICE
Entity Type:Organization
Organization Name:STALLER FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-874-6063
Mailing Address - Street 1:23 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2113
Mailing Address - Country:US
Mailing Address - Phone:732-874-6063
Mailing Address - Fax:
Practice Address - Street 1:23 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2113
Practice Address - Country:US
Practice Address - Phone:732-874-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-16
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center